[Risk approach in the diagnosis of malaria in high altitude regions].

P Van der Stuyft, L Manirankunda, C Delacollette
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Abstract

Sixteen cases of malaria are reported per thousand inhabitants per year in Kayanza, a province in the High Plateaux of Burundi. A case control study was conducted between October 1990 and March 1991 to better document this phenomenon. The majority of confirmed cases presented in persons who had recently sojourned in an endemic area (relative risk = 18). All except one of the other patients were carriers of plasmodium species that can cause late recurrences, which is compatible with the absence of local transmission. The presumptive diagnosis of malaria, as it is routinely made in the health centres, is not very specific (60%) and it has a positive predictive value of only 10%. This implies that an anti-malaria treatment is useless for 90% of the patients who receive it. It also means that the true malaria incidence rate in Kayanza can be estimated at less than 1 per thousand per year. We propose an alternative diagnostic strategy based on the risk differences between population sub-groups. It should permit an adequate patient management and a satisfactory surveillance of malaria in non-endemic epidemiological strata.

[高海拔地区疟疾诊断中的风险方法]。
据报告,在布隆迪高原的卡扬扎省,每年每千名居民中有16例疟疾病例。1990年10月至1991年3月期间进行了一项病例对照研究,以更好地记录这一现象。大多数确诊病例出现在最近在流行地区逗留的人群中(相对风险= 18)。除1名患者外,其余患者均为可引起晚期复发的疟原虫携带者,这与没有本地传播是一致的。在保健中心例行进行的疟疾推定诊断并不十分具体(60%),阳性预测值仅为10%。这意味着抗疟疾治疗对90%接受治疗的患者无效。这也意味着,Kayanza的真实疟疾发病率可以估计为每年不到千分之一。我们提出了一种基于人群亚组之间风险差异的替代诊断策略。它应允许在非地方性流行病学阶层对疟疾进行适当的病人管理和令人满意的监测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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